- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $11.22 / $69.18
| Facility | | $4.17 | $11.22 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.69 / $9.77
| Professional | | $2.00 | $2.69 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $1.82 / $2.19
| Professional | | $1.82 | $1.82 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.24 / $3.63 / $4.27
| Facility | | $3.24 | $3.63 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.63 / $4.37
| Professional | | $3.02 | $3.63 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.63 / $9.33
| Facility | | $2.45 | $3.63 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $3.39 / $6.46
| Professional | | $1.82 | $3.39 | $6.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $12.88 / $28.18
| Facility | | $2.95 | $12.88 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $4.17
| Professional | | $2.19 | $2.19 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $2.19
| Professional | | $1.74 | $1.74 | $2.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.51 / $2.45 / $3.72
| Facility | | $1.51 | $2.45 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.78 / $4.17
| Professional | | $1.45 | $1.78 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.19 / $3.63
| Professional | | $2.19 | $2.19 | $3.63 |